Arteriosclerosis and Coronary Heart Disease (CHD)

1. Arteriosclerosis and Coronary Heart Disease (CHD)

2. Arteriosclerosis • Disease of the arteries characterized by thickening, loss of elasticity and calcification of arterial walls • Resulting in decreased blood supply particularly to the cerebrum and lower extremities • Often develops with: • aging • hypertension • diabetes

4. Progression of Arteriosclerosis

5. Coronary Heart Disease (CHD) • Seven million Americans effected • Caused by narrowing of the coronary arteries • No. 1 killer of men and women in U.S. • >500,000 each year • > 60 million Americans have some form of coronary vascular disease (CVD) including high BP, CAD, CHD, congestive heart failure, myocardial infarction and others • >2,600 Americans die each day of CVD, i.e., 1 death/33 sec • ~ $299 billion cost to the U.S.

6. Risk factors • High blood pressure (hypertension) • High blood cholesterol • Smoking • Obesity • Physical inactivity • Diabetes • Stress (?) Controllable

8. Risk Factors (cont’d) • Gender • Heredity • Age Uncontrollable

9. Major Risk Factors:The Big Three • Hypertension • High cholesterol • Cigarette smoking All three increase risk factor eight times AND….we should addLACK OF EXERCISE

11. Hypertension • Commonly called high blood pressure • Systolic and diastolic measurements • Normal systolic - 110-130 mmHg • Normal diastolic - 70-90 mm Hg

12. Symptoms of CHD • Chest pain (angina) • Shortness of breath • Heaviness, tightness, pain, burning, pressure or squeezing • behind the breastbone or in the arms, neck, or jaws • Pain may vary • Perhaps no pain

13. Cause & Consequencess of CHD • Lack of oxygen due to ischemia (lack of blood supply) • Narrowing of coronary arteries • Heart responds with angina • Finally, heart attack (myocardial infarction • local ischemia usually due to thrombus (clot) or embolus (clot that has moved from another site and lodged in a smaller vessel) • Possible permanent damage

14. Diagnosis of CHD • Electrocardiogram (EKG) • Stress test • Nuclear scanning • Coronary angiography

15. Treatment for CHD • Lifestyle changes • Medication • Surgery

16. Lifestyle Changes • Change of habits • Low fat diet • Lower weight • Increase exercise • Stop smoking

19. Medications to Treat CHD • Beta blockers • Nitroglycerine and other nitrates • Calcium-channel blockers • Aspirin • Cholesterol-lowering drugs • lovastatin, colestipol, cholestyramine, etc • Digitalis • ACE inhibitors • Diuretics

20. Surgery to Treat CHD • Balloon angioplasty • Atherectomy • Laser angioplasty • Stent insertion • Coronary artery bypass operation (CABG)

22. Gender Disparity • Coronary Artery Disease (CAD) more common in men • Women have higher mortality rates • Older and sicker when first heart attack occurs • Less aggressively treated than men • Failure to recognize symptoms in timely fashion • MI in young, healthy women is rare • Occurrence greater in those who use OC • Age 30-39: 2.7X; 40-44: 5.7X; (complilcated by cigarette use)

25. Effects of Smoking • For adult males, smoking has declined from 53 % to 38% • For women, remains at 30% • Has increased for younger and teenaged women • Heavy smoker = 20- 30 cigs/day

26. Effects of Smoking (cont’d) • Cigs contain about 2000 compounds • Main harmful are tar, nicotine and CO • Tar contains hydrocarbons and other carcinogenic substances • Nicotine causes release of epinephrine and norepinephrine resulting in increased HR, BP, cardiac output, stroke volume, contractility, oxygen consumption, and coronary blood flow • CO reduces oxygen carrying capacity of the blood; can precipitate angina

27. Effects of Smoking (cont’d) • Contributes to development of atherosclerosis • Lowers levels of HDL • causes deterioration of elasticity of vessels • Responsible for 20% of all deaths from heart disease • Female smokers have a higher risk than male smokers

30. Sociocultural Mobility Socioeconomic Status Status Incongruity Education Level Anxiety and Neuroses Life Dissatisfaction Life Change Behavior Pattern STRESS

31. Signs of Preclinical CVD • Left ventricular hypertrophy (LVH) associated with increased CAD risk (Framingham Study) • Definite LVH-EKG increased CAD risk threefold

32. Blood and Tissue Characteristics • Type O = lower cholesterol • Higher cholesterol contributes to higher rate of CAD • HDL:LDL (high density lipoproteins: low density lipoproteins) ratio may be more important than cholesterol level

33. HDL • High density lipoproteins seem to have protective effect against development of atherosclerosis(a form or arteriosclerosis in which deposits of yellowish plaque containing cholesterol, lipoid substances and lipophages are formed within large and medium-sized arteries) • Women have higher concentrations than men • Most important of all lipid risk factors • Below 35 mg/dl----- 8X incidence of CAD compared to those with 65 mg/dl • Moderate alcohol intake may have + effect • Exercise has + effect • Greater weight has a negative effect

34. DIET • Reduce saturated fats • Increase polyunsaturated fats • Higher protein to fat ratio • Count calories

36. Effects of Exercise

38. Additional Information